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Acute aortic dissection — RCPSC EM MCQ

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HardCardiovascular emergenciesAcute aortic dissectionRCPSC EM

A 71-year-old has tearing chest pain radiating to the back, right arm BP 182/94 and left arm BP 148/82. ECG shows nonspecific ST changes, troponin is mildly elevated, and chest X-ray shows a widened mediastinum. What is the most appropriate investigation?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — CT angiography of the aorta after initial stabilisation

Pulse/BP differential, tearing pain and mediastinal widening strongly suggest acute aortic syndrome; CTA is the key investigation in a stable patient.

Reference: Canadian emergency cardiovascular imaging practice; CCS chest pain guidance